Paediatric surgery: annular pancreas: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Paediatric surgery: annular pancreas

Sample item

At laparotomy in a neonate with duodenal obstruction, a ring of pancreatic tissue completely encircles the second part of the duodenum. What is the appropriate operation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Duodenoduodenostomy bypassing the ring

In annular pancreas the ring is not divided or resected because of the risk of pancreatic fistula and pancreatitis. The obstruction is bypassed with a duodenoduodenostomy or duodenojejunostomy. The association with Down syndrome is well known.

Option by option

  • A. Duodenoduodenostomy bypassing the ring (correct)

    Correct. Bypass by duodenoduodenostomy relieves the obstruction without injuring the ring.

  • B. Division of the pancreatic ring

    Dividing the pancreatic ring risks fistula and pancreatitis.

  • C. Gastrojejunostomy with vagotomy

    Gastrojejunostomy with vagotomy is an adult ulcer operation and is not used for neonatal duodenal obstruction.

  • D. Resection of the ring with the duodenum

    Resection of the ring with the duodenum is a major operation with the same risk of fistula.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Duodenoduodenostomy bypassing the ring. In annular pancreas the ring is not divided or resected because of the risk of pancreatic fistula and pancreatitis.

Why is "Division of the pancreatic ring" not the answer?

Dividing the pancreatic ring risks fistula and pancreatitis.

Why is "Gastrojejunostomy with vagotomy" not the answer?

Gastrojejunostomy with vagotomy is an adult ulcer operation and is not used for neonatal duodenal obstruction.

Why is "Resection of the ring with the duodenum" not the answer?

Resection of the ring with the duodenum is a major operation with the same risk of fistula.

What concept does this question test?

It tests Paediatric surgery: annular pancreas in General Surgery. The obstruction is bypassed with a duodenoduodenostomy or duodenojejunostomy. The association with Down syndrome is well known.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric surgery: annular pancreas?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.